BACK SPRAIN, LUMBO-DORSAL REGION |
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General Information
DEFINITION--Violent overstretching of one or more ligaments in the lumbo-dorsal vertebrae of the spine. This is the most stable section of the vertebral column. Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains. When the ligament is overstretched, it becomes tense and gives way at its weakest point, either where it attaches to bone or within the ligament itself. If the ligament pulls loose a fragment of bone, it is called a SPRAIN-FRACTURE. There are 3 types of sprains:
Mild (Grade I)--Tearing of some ligament fibers and associated muscle spasm. There is no loss of function.
Moderate (Grade II)--Rupture of a portion of the ligament, resulting in some loss of function.
Severe (Grade III)--Complete rupture of the ligament or complete separation of ligament from bone. There is total loss of function. A severe sprain requires surgical repair.
BODY PARTS INVOLVED
Any of the many ligaments connecting the vertebrae in the lumbo-dorsal spine.
Tissue surrounding the sprain, including blood vessels, tendons, bone, periosteum (covering of bone) and muscles.
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SIGNS & SYMPTOMS
Severe pain at the time of injury.
Popping or feeling of tearing in the back.
Tenderness at the injury site.
Swelling in the back.
Bruising that appears soon after injury.
CAUSESStress on a ligament that temporarily forces the lumbo-dorsal vertebrae out of their normal location. A sprain of the lumbo-dorsal vertebrae will frequently occur when a stressful act is performed when the athlete is off-balance, or during repeated stressful activity involving muscles in the lumbo-dorsal area.
RISK INCREASES WITH
Contact, throwing and lifting sports.
Gymnastics or diving.
Previous spine injury.
Obesity.
Poor muscle conditioning.
HOW TO PREVENT
Build your strength with a conditioning program appropriate for your sport.
Warm up before practice or competition.
Tape vulnerable joints before practice or competition to prevent reinjury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis.
Application of tape, cast (rare) or elastic bandage.
Self-care during rehabilitation.
Physical therapy (moderate or severe sprain).
Hospitalization (rare) for traction.
Surgery (severe sprain).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the the spine to rule out fractures.
POSSIBLE COMPLICATIONS
Prolonged healing time if usual activities are resumed too soon.
Proneness to repeated back injury.
Inflammation at the ligament attachment to bone (periostitis).
Prolonged disability (sometimes).
Unstable or arthritic spine following repeated injury.
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Ligaments have a poor blood supply, and torn ligaments require as much healing time as fractures. Average healing times are:
Mild sprains--2 to 6 weeks.
Moderate sprains--6 to 8 weeks.
Severe sprains--8 to 10 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CAREIf your doctor does not apply a cast, tape or elastic bandage:
Continue using an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured area. Use for 20 minutes at a time.
Wrap the injured area from the top of the hip to the lower rib cage with an elasticized bandage between ice treatments.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
Massage gently and often to provide comfort and decrease swelling.
Ask your doctor about the advisability of using a special corset.
MEDICATION
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain.
Injection of a corticosteroid, such as triamcinolone, to reduce inflammation.
ACTIVITYResume your normal activities gradually after clearance from your doctor.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises when the cast or supportive wrapping is no longer necessary.
Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe lumbo-dorsal back sprain, or a mild sprain persists longer than 2 weeks.
Pain, swelling or bruising worsens despite treatment.
Pain develops in the leg.
Any of the following occur after surgery:
Increased pain, swelling, redness, drainage or bleeding in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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